Lining in the uterus too thick. Endometrial Hyperplasia: Causes, Symptoms, and Treatment Options

25.07.202327.06.2023 by alexxlab

What is endometrial hyperplasia. How is it diagnosed. What are the risk factors for developing this condition. What treatment options are available for endometrial hyperplasia. How can you reduce your risk of developing this condition.

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Understanding Endometrial Hyperplasia: An Overview

Endometrial hyperplasia is a condition characterized by an abnormal thickening of the uterine lining (endometrium). This rare condition affects approximately 133 out of 100,000 women and can potentially lead to uterine cancer in some cases. To fully grasp the nature of this condition, it’s essential to understand the normal menstrual cycle and how hormonal imbalances can disrupt it.

During a typical menstrual cycle, the endometrium undergoes changes in response to hormonal fluctuations. Estrogen produced by the ovaries causes the endometrium to thicken, preparing the uterus for a potential pregnancy. After ovulation, progesterone levels rise, further preparing the uterus to receive a fertilized egg. If pregnancy doesn’t occur, estrogen and progesterone levels drop, resulting in the shedding of the uterine lining (menstruation).

However, when there’s a hormonal imbalance—specifically, an excess of estrogen without adequate progesterone to counterbalance it—the endometrium may continue to thicken and grow excessively. This abnormal growth is what we refer to as endometrial hyperplasia.

Types of Endometrial Hyperplasia: Understanding the Differences

Endometrial hyperplasia is classified into two main types based on the cellular changes observed in the endometrium:

Simple endometrial hyperplasia (without atypia): This type involves an overgrowth of normal cells that are unlikely to be cancerous. In many cases, this condition may improve without treatment.
Simple or complex atypical endometrial hyperplasia: This type is considered precancerous and results from an overgrowth of abnormal cells. If left untreated, it has the potential to develop into uterine or endometrial cancer.

Understanding the type of endometrial hyperplasia is crucial for determining the appropriate treatment approach and assessing the risk of cancer development.

Recognizing the Symptoms of Endometrial Hyperplasia

Identifying the symptoms of endometrial hyperplasia is crucial for early detection and treatment. The most common symptoms include:

Heavy menstrual bleeding
Bleeding that occurs after menopause
Menstrual cycles shorter than 21 days

It’s important to note that these symptoms can also be indicative of other gynecological conditions. Therefore, if you experience any of these symptoms, it’s essential to consult with a healthcare professional for a proper diagnosis.

When to Seek Medical Attention

While occasional changes in menstrual patterns are normal, persistent irregularities or any postmenopausal bleeding should prompt a visit to your healthcare provider. Early detection can significantly improve treatment outcomes and reduce the risk of complications.

Diagnosing Endometrial Hyperplasia: A Comprehensive Approach

Accurate diagnosis of endometrial hyperplasia involves a combination of physical examination, medical history review, and diagnostic tests. The diagnostic process typically includes the following steps:

Physical examination and medical history: Your doctor will conduct a thorough physical exam and inquire about your symptoms, menstrual history, and other relevant medical information.
Transvaginal ultrasound: This imaging technique uses sound waves to create images of your uterus, allowing your doctor to assess the thickness of the endometrium.
Endometrial biopsy: A small sample of tissue is taken from the uterine lining and examined under a microscope to check for abnormal cells.
Hysteroscopy: In some cases, your doctor may use a thin, lighted tube (hysteroscope) to visually examine the inside of your uterus and identify any abnormalities.
Dilation and curettage (D&C): This procedure involves dilating the cervix and removing tissue from the uterus for further examination.

These diagnostic tools help healthcare providers determine the presence and extent of endometrial hyperplasia, guiding treatment decisions and assessing the risk of cancer development.

Treatment Options for Endometrial Hyperplasia: A Tailored Approach

The treatment of endometrial hyperplasia aims to address the underlying hormonal imbalance and prevent the progression to cancer. The choice of treatment depends on various factors, including the type of hyperplasia, the patient’s age, overall health, and desire for future fertility.

Hormonal Therapy

Progestin, a synthetic form of progesterone, is the most common treatment for endometrial hyperplasia. It can be administered in several ways:

Oral medication
Injections
Vaginal cream
Intrauterine device (IUD)

Treatment typically lasts for at least six months, with regular follow-up appointments to monitor progress. Patients who are obese or treated with oral progestin may have a higher risk of relapse and may require annual check-ups.

Surgical Intervention

In some cases, a hysterectomy (surgical removal of the uterus) may be recommended. This option is typically considered when:

Atypical endometrial hyperplasia develops during treatment
There’s no improvement after 12 months of treatment
The condition relapses or worsens
Bleeding persists despite treatment

It’s important to note that a hysterectomy will result in permanent infertility. Therefore, this option should be carefully discussed with your healthcare provider, taking into account your individual circumstances and future family planning goals.

Risk Factors for Endometrial Hyperplasia: Identifying Vulnerable Populations

Understanding the risk factors associated with endometrial hyperplasia can help in early detection and prevention. Some of the key risk factors include:

Menopausal transition (perimenopause) or menopause
Family history of colon, ovarian, or uterine cancer
Diabetes
Nulliparity (never having been pregnant)
Obesity
Polycystic ovary syndrome (PCOS)
Smoking
Gallbladder disease
Thyroid disorders
Certain breast cancer treatments
Hormone therapy
Early onset of menstruation
Late menopause

Recognizing these risk factors can help individuals and healthcare providers take appropriate preventive measures and ensure regular screening for those at higher risk.

Prevention Strategies: Reducing Your Risk of Endometrial Hyperplasia

While it’s not always possible to prevent endometrial hyperplasia, there are several steps you can take to lower your risk:

Maintain a healthy weight: Obesity is a significant risk factor for endometrial hyperplasia. Adopting a balanced diet and regular exercise routine can help manage weight and reduce risk.
Manage underlying health conditions: Proper management of conditions like diabetes and PCOS can help reduce the risk of hormonal imbalances that contribute to endometrial hyperplasia.
Consider hormonal birth control: Use of combination birth control pills or progestin-only methods can help regulate hormonal balance and reduce the risk of endometrial hyperplasia.
Quit smoking: Smoking is associated with an increased risk of endometrial hyperplasia. Quitting can improve overall health and reduce this risk.
Regular check-ups: Routine gynecological exams and open communication with your healthcare provider about any menstrual irregularities can aid in early detection and treatment.

While these strategies can help reduce risk, it’s important to remember that some risk factors, such as genetic predisposition or age, cannot be modified. Regular screenings and prompt attention to any unusual symptoms remain crucial for early detection and management of endometrial hyperplasia.

Complications of Endometrial Hyperplasia: Understanding the Potential Risks

While endometrial hyperplasia itself is not cancer, it can lead to serious complications if left untreated. The most significant concern is the potential progression to endometrial cancer, particularly in cases of atypical hyperplasia. Other potential complications include:

Chronic anemia: Due to prolonged or heavy menstrual bleeding, some women may develop iron-deficiency anemia.
Fertility issues: In some cases, endometrial hyperplasia can interfere with normal fertility, making it more difficult to conceive.
Increased risk of other gynecological conditions: Women with endometrial hyperplasia may be at higher risk for other uterine disorders.

Understanding these potential complications underscores the importance of early detection, proper treatment, and regular follow-up care for individuals diagnosed with endometrial hyperplasia.

Long-term Outlook and Management

The prognosis for endometrial hyperplasia is generally good, especially when detected and treated early. Most cases of simple hyperplasia without atypia respond well to hormonal therapy and may even resolve on their own. However, cases involving atypical cells require more aggressive treatment and closer monitoring due to the increased risk of cancer development.

Long-term management of endometrial hyperplasia typically involves:

Regular follow-up appointments with your healthcare provider
Periodic endometrial biopsies to monitor for any cellular changes
Ongoing hormonal therapy, if prescribed
Lifestyle modifications to address risk factors
Vigilant attention to any recurrence of symptoms

By adhering to these management strategies and maintaining open communication with your healthcare team, you can effectively manage endometrial hyperplasia and minimize the risk of complications.

Advances in Research and Future Directions

The field of gynecological health is continually evolving, with ongoing research aimed at improving our understanding and treatment of conditions like endometrial hyperplasia. Some promising areas of research include:

Biomarker identification: Scientists are working to identify specific biomarkers that could allow for earlier and more accurate diagnosis of endometrial hyperplasia and prediction of cancer risk.
Targeted therapies: Research is underway to develop more targeted treatments that can effectively address hormonal imbalances with fewer side effects.
Improved imaging techniques: Advanced imaging technologies are being explored to enhance the accuracy of non-invasive diagnostic methods.
Genetic profiling: Understanding the genetic factors that contribute to endometrial hyperplasia could lead to more personalized prevention and treatment strategies.

These advancements hold the promise of improved outcomes for women affected by endometrial hyperplasia, potentially reducing the need for invasive procedures and enhancing quality of life.

The Role of Patient Education and Advocacy

As research progresses, patient education and advocacy play crucial roles in improving outcomes for those affected by endometrial hyperplasia. Increased awareness of symptoms, risk factors, and the importance of regular check-ups can lead to earlier detection and more effective treatment.

Moreover, patient advocacy groups can help drive research funding, promote policy changes to improve access to care, and provide support networks for individuals navigating a diagnosis of endometrial hyperplasia.

By staying informed about the latest developments in endometrial health and actively participating in their healthcare decisions, patients can play a pivotal role in managing their condition and contributing to the broader understanding of endometrial hyperplasia.

Endometrial Hyperplasia: Causes and Treatment

Written by Sharlene Tan

Medically Reviewed by Jabeen Begum, MD on November 17, 2021

What Is Endometrial Hyperplasia?
What Are the Types of Endometrial Hyperplasia?
What Are the Causes of Endometrial Hyperplasia?
What Are the Symptoms of Endometrial Hyperplasia?
How Is Endometrial Hyperplasia Diagnosed?
What Is the Treatment for Endometrial Hyperplasia?
Are There Risk Factors for Getting Endometrial Hyperplasia?
Can You Prevent Endometrial Hyperplasia?
Complications of Endometrial Hyperplasia
More

Endometrial hyperplasia is a condition in which the lining of your womb becomes too thick. In some women, this can lead to cancer of the uterus. Endometrial hyperplasia is rare. It affects about 133 out of 100,000 women.

Your endometrium is the lining of your uterus (womb). During your menstrual cycle, your endometrium changes. The estrogen that your ovaries produce makes your endometrium thicken. This prepares your uterus for possible pregnancy.

After the release of an egg from your ovary (ovulation), your progesterone level increases. This hormone gets your uterus ready to receive an egg. If pregnancy doesn’t happen, your estrogen and progesterone levels drop. This leads to the shedding of the lining (menstruation).

If there’s a hormonal imbalance, however, your endometrium can thicken and grow too much. This abnormal growth is endometrial hyperplasia.

There are two types of endometrial hyperplasia based on the kind of cell changes in your endometrium:

Simple endometrial hyperplasia (without atypia). This type consists of normal cells that aren’t likely to be cancerous. This condition may improve without treatment.
Simple or complex atypical endometrial hyperplasia. This type is precancerous and results from an overgrowth of abnormal cells. If untreated, it may turn into uterine or endometrial cancer.

Endometrial hyperplasia is caused by too much estrogen and not enough progesterone. If there’s too little progesterone, your uterus isn’t triggered to shed its lining (menstruation). The lining continues to thicken due to estrogen. The cells in the lining may crowd together and become irregular.

The symptoms of endometrial hyperplasia include:

Heavy menstrual bleeding
Bleeding that happens after menopause
Menstrual cycles that are shorter than 21 days

Your doctor will conduct a physical exam and take into account your medical history. They may ask about your symptoms and menstrual history, such as the ages you started menstruation and menopause.

Many different conditions can cause unusual bleeding, so your doctor may carry out some of these diagnostic tests:

Ultrasound. Your doctor may perform a transvaginal ultrasound to see if your lining is thick. They will insert a small device into your vagina. This device uses sound waves, which are converted into images of your uterus. If your endometrium is thick, that may mean that you have endometrial hyperplasia.

Biopsy. You may also need to have a biopsy. Your doctor will remove a sample of tissue from your uterus lining. This will be tested in a lab to see if it’s cancerous.

Hysteroscopy. A hysteroscope is a thin, lighted, flexible tube. Your doctor will use it to look inside your uterus for any abnormalities. They may also perform a biopsy or a dilation and curettage (D&C).

During a dilation and curettage, your doctor will open (dilate) your cervix, which is the opening of your uterus. They’ll then use a thin instrument called a curette to remove tissue from your uterus.

Most cases of endometrial hyperplasia are treatable. A common treatment is progestin, a manmade progesterone.

Your doctor may prescribe progestin in a few different ways:

Orally
Via injections
In vaginal cream
In an intrauterine device (IUD)

You’ll likely need to be treated for at least six months. You’re at a higher risk of relapse if you’re obese or treated with oral progestin, and you may need follow-up appointments every year.

Hysterectomy. Your doctor may recommend a surgery to remove your uterus (hysterectomy) if:

During your treatment, atypical endometrial hyperplasia develops
After 12 months of treatment, there’s no improvement
You have a relapse or worsening of your condition
Your bleeding doesn’t stop

After a hysterectomy is performed, you’ll no longer be able to get pregnant. Talk to your doctor to find out what’s the best treatment for you.

You’re at a higher risk for endometrial hyperplasia if you have these risk factors:

Menopause transition (perimenopausal) or menopause
A family history of colon, ovarian, and uterine cancer
Diabetes
Having never been pregnant
Obesity
Polycystic ovary syndrome (PCOS)
Smoking
Gallbladder disease
Thyroid disease
Certain breast cancer treatments
Hormone therapy
Early age of menstruation
Older age of menopause

You can’t prevent endometrial hyperplasia, but you can lower your risk with these steps:

Quit smoking.
Maintain a healthy weight.
If you use hormone therapy, take progestin along with estrogen.
Take birth control to regulate your menstrual cycle and hormones.

If left untreated, atypical endometrial hyperplasia can become cancerous. About 8% of women with simple atypical endometrial hyperplasia who don’t get treatment develop cancer. Nearly 30% of those with untreated complex atypical endometrial hyperplasia develop cancer.

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Endometrial Hyperplasia: Causes and Treatment

Written by Sharlene Tan

Medically Reviewed by Jabeen Begum, MD on November 17, 2021

What Is Endometrial Hyperplasia?
What Are the Types of Endometrial Hyperplasia?
What Are the Causes of Endometrial Hyperplasia?
What Are the Symptoms of Endometrial Hyperplasia?
How Is Endometrial Hyperplasia Diagnosed?
What Is the Treatment for Endometrial Hyperplasia?
Are There Risk Factors for Getting Endometrial Hyperplasia?
Can You Prevent Endometrial Hyperplasia?
Complications of Endometrial Hyperplasia
More

If there’s a hormonal imbalance, however, your endometrium can thicken and grow too much. This abnormal growth is endometrial hyperplasia.

There are two types of endometrial hyperplasia based on the kind of cell changes in your endometrium:

Simple endometrial hyperplasia (without atypia). This type consists of normal cells that aren’t likely to be cancerous. This condition may improve without treatment.
Simple or complex atypical endometrial hyperplasia. This type is precancerous and results from an overgrowth of abnormal cells. If untreated, it may turn into uterine or endometrial cancer.

The symptoms of endometrial hyperplasia include:

Heavy menstrual bleeding
Bleeding that happens after menopause
Menstrual cycles that are shorter than 21 days

Your doctor will conduct a physical exam and take into account your medical history. They may ask about your symptoms and menstrual history, such as the ages you started menstruation and menopause.

Many different conditions can cause unusual bleeding, so your doctor may carry out some of these diagnostic tests:

Biopsy. You may also need to have a biopsy. Your doctor will remove a sample of tissue from your uterus lining. This will be tested in a lab to see if it’s cancerous.

Most cases of endometrial hyperplasia are treatable. A common treatment is progestin, a manmade progesterone.

Your doctor may prescribe progestin in a few different ways:

Orally
Via injections
In vaginal cream
In an intrauterine device (IUD)

You’ll likely need to be treated for at least six months. You’re at a higher risk of relapse if you’re obese or treated with oral progestin, and you may need follow-up appointments every year.

Hysterectomy. Your doctor may recommend a surgery to remove your uterus (hysterectomy) if:

During your treatment, atypical endometrial hyperplasia develops
After 12 months of treatment, there’s no improvement
You have a relapse or worsening of your condition
Your bleeding doesn’t stop

After a hysterectomy is performed, you’ll no longer be able to get pregnant. Talk to your doctor to find out what’s the best treatment for you.

You’re at a higher risk for endometrial hyperplasia if you have these risk factors:

Menopause transition (perimenopausal) or menopause
A family history of colon, ovarian, and uterine cancer
Diabetes
Having never been pregnant
Obesity
Polycystic ovary syndrome (PCOS)
Smoking
Gallbladder disease
Thyroid disease
Certain breast cancer treatments
Hormone therapy
Early age of menstruation
Older age of menopause

You can’t prevent endometrial hyperplasia, but you can lower your risk with these steps:

Quit smoking.
Maintain a healthy weight.
If you use hormone therapy, take progestin along with estrogen.
Take birth control to regulate your menstrual cycle and hormones.

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Pathology of the uterine cavity.

Causes.

Home » Infertility treatment » Pathology of the uterine cavity. Causes.

The uterus is a pear-shaped muscular organ located in the small pelvis. The uterus is represented by three layers – internal (endometrium, uterine cavity mucosa), middle (myometrium, muscular layer of the uterus), external (serous, visceral peritoneum covering the uterus from the abdominal cavity).

The uterus consists of the body of the uterus and the cervix. The body of the uterus communicates with the vagina through the cervical canal of the cervix and with the abdominal cavity through the fallopian tubes. Of all three layers of the uterus, only the inner lining of the uterine body undergoes cyclic changes – the mucous membrane of the uterine cavity – the endometrium.

The endometrium is divided into 2 layers: functional (upper) and basal (lower). On the first day of menstruation, there is a sharp decrease in the level of progesterone and the rejection of the functional layer of the endometrium occurs, which is manifested by menstrual bleeding. In the first phase of the menstrual cycle (from 1 to 14-16 days of the cycle), under the action of estradiol, proliferation (thickening) of the endometrium occurs up to 11-13 mm. When a smaller size of the endometrium is reached, pregnancy is unlikely or subsequently leads to the threat of termination of pregnancy. After ovulation and due to the changing hormonal background for progesterone, the endometrium matures and prepares for the adoption of a fertilized egg. When pregnancy occurs, under the action of chorionic gonadotropin (hCG), the endometrium continues to function in order to provide the embryo with nutrients. In the absence of pregnancy, endometrial rejection occurs. There are certain limits to the thickness of the endometrium for each day of the menstrual cycle. If the thickness of the endometrium is less than normal, we can talk about thin endometrium (endometrial hypotrophy), with an increase in the size of the thickness of the endometrium, we can talk about pathological thickening of the endometrium (endometrial hyperplasia). Normally, the thickness of the endometrium in the first 2 days after the end of menstruation should be no more than 3 mm, and on periovulatory days, at least 10 mm.

Both congenital anomalies in the development of the uterus and acquired diseases of the uterine cavity are the cause of infertility.

Such developmental anomalies and diseases include the following diseases:

Unicornuate and bicornuate uterus.
Hypoplasia (underdevelopment) of the uterus, rudimentary uterus.
Complete and incomplete septum of the uterine cavity.
Pathology of the uterine cavity (endometrial hyperplasia, endometrial polyposis, endometrial polyp).
Endometriosis of the uterus.
Intramural uterine fibroids with centripetal growth.
Submucosal uterine fibroids.

The above pathology occurs in 10% of cases of infertility and miscarriage.

Uterine infertility is associated with the presence of pathology not only in the endometrium, but also in the myometrium (the muscular layer of the uterus).

Endometrial polyp – pathological focal growth of the uterine mucosa due to inflammatory diseases of the uterine cavity (endometritis), hormonal disorders (hyperandrogenism, hyperestrogenemia, hyperprolactinemia), ovarian tumors (ovarian cysts), uterine tumors (uterine fibroids). The endometrial polyp is a pathological structure in the uterine cavity that prevents the implantation of the embryo. Sometimes the formation of an endometrial polyp occurs without obvious reasons. In this case, the formation of an endometrial polyp is due to the presence of a pathological receptor apparatus that perversely perceives the normal level of female sex hormones. When an endometrial polyp is detected in women planning a pregnancy, surgical treatment should be performed strictly with the help of hysteroresectoscopy. Hysteroresectoscopy is a method of surgical treatment of intrauterine pathology using an electric loop. Only performing hysteresectoscopy in patients of reproductive age makes it possible to avoid recurrence of the endometrial polyp and return to pregnancy planning after 2 months. During hysteroresectoscopy, the polyp stem is treated with high-frequency energy, which helps prevent the recurrence of the endometrial polyp due to its performance under visual control with high magnification. Performing the removal of a polyp by scraping the uterine cavity in women planning a pregnancy is unacceptable, as this leads to unnecessary trauma to the healthy endometrium around the polyp with the development of infertility and miscarriage.
Endometrial hyperplasia is a diffuse thickening of the endometrium with a change in structure that does not correspond to the day of the menstrual cycle. The cause of the development of endometrial hyperplasia is hyperestrogenism, dysfunction of the hypothalamic-pituitary system, diseases of the thyroid gland and adrenal glands. Both endometrial hyperplasia itself and the causes leading to it cause infertility. Treatment of endometrial hyperplasia consists of two stages – surgical and anti-relapse hormonal. In the surgical treatment of endometrial hyperplasia, diagnostic hysteroscopy is necessarily performed first, the diagnosis of endometrial hyperplasia is confirmed or refuted, and only then the issue of the advisability of performing therapeutic and diagnostic curettage of the uterine cavity is resolved. Anti-relapse hormonal treatment is prescribed upon receipt of the results of the histological conclusion and depending on the desire to plan a pregnancy in the near future. In the absence of adequate treatment, atypical endometrial hyperplasia occurs with the subsequent development of endometrial cancer.
Intrauterine synechia (adhesions in the uterine cavity) – adhesions of the anterior and posterior walls of the uterus with limitation of the volume of the uterine cavity. In this case, implantation and subsequent pregnancy becomes impossible. Most often, the cause of the development of intrauterine synechia is inflammation in the uterine cavity, trauma to the uterine cavity during abortion or curettage of the uterine cavity, endometriosis of the uterus. The destruction of intrauterine synechia is carried out by hysteroresectoscopy – in the aquatic environment under visual control using an electric loop, adhesions in the uterine cavity are dissected. With pronounced synechia in the uterine cavity, the dissection can be performed in two stages under the control of laparoscopy. After dissection of intrauterine synechia, hormone therapy is necessarily prescribed for 6 months, after which pregnancy planning is carried out.
Chronic endometritis is an inflammation of the uterine mucosa after an infection or traumatic interventions in the uterine cavity (complicated childbirth, accompanied by intrauterine intervention – manual examination of the uterine cavity, curettage of the uterine cavity with the remains of placental tissue). Acute endometritis is always accompanied by fever, purulent discharge from the uterine cavity, sharp sharp pains in the lower abdomen. In chronic endometritis, such a clinical picture was not noted – minor pulling or aching pains in the lower abdomen and scanty spotting spotting before and after menstruation are disturbing. The main symptom of endometritis is infertility and miscarriage. Very often, in the presence of chronic endometritis, according to ultrasound of the small pelvis, a thin endometrium is noted. Endometrium in chronic endometritis not only does not reach normal thickness, but also does not undergo cyclic changes. In order to correct endometritis before conception, it is recommended to carry out hormonal and physiotherapeutic treatment along with antibacterial and anti-inflammatory therapy.
Endometriosis of the uterus is the penetration and growth of the endometrium into the muscular layer of the uterus. There are diffuse and diffuse-nodular forms of adenomyosis. The main clinical symptoms in the presence of uterine endometriosis are uterine bleeding and debilitating pain in the lower abdomen. In the presence of endometriosis, leading to deformation of the uterine cavity, surgical treatment is performed followed by hormonal treatment.
Uterine fibroids – a benign tumor of the muscular layer of the uterus. Like submucosal uterine fibroids, large fibroids prevent pregnancy and gestation. The exact mechanism of the effect of uterine fibroids on the embryo has not been clarified. In the presence of large uterine fibroids and submucosal location, it is required to remove it before planning a pregnancy. Planning for pregnancy after removal of uterine fibroids should be carried out only after 12 months from the date of surgical treatment. Location and size have a very strong influence. In the presence of uterine fibroids of small size and its subserous location, planning of pregnancy and childbirth through the natural birth canal is possible. Most of the drugs used in IVF are contraindicated in the presence of uterine fibroids, as they cause the growth of tumors. The behavior of uterine fibroids during pregnancy is unpredictable, but most often there is an increase in myomatous nodes. In the surgical treatment of uterine fibroids in women of reproductive age, it is always possible to perform the removal of only tumors, that is, to perform a conservative myomectomy.
Complete and incomplete septum of the uterine cavity is a congenital anatomical change that most often interferes with the full bearing of pregnancy. When pregnancy attaches to the uterine septum in the early stages, the death of the embryo occurs due to inadequate blood supply. When planning pregnancy, the intrauterine septum is dissected using hysteroresectoscopy, followed by the appointment of hormone therapy. Planning for pregnancy after dissection of a complete or incomplete intrauterine septum should be carried out strictly after 6 months.
Thin endometrium can be noted as an individual feature of the patient throughout the entire menstrual cycle or develop as a result of endometritis, uterine endometriosis. Also, a thin endometrium can be the cause of impaired blood supply to the uterus or inferiority of the receptor apparatus of the uterus. In the presence of a thin endometrium, the likelihood of pregnancy is reduced. When planning a pregnancy, the thin endometrium is corrected by the use of hormonal and vascular drugs.
Pathology of the uterine cavity is detected and treated by hysteroscopy. This method is divided into two types: diagnostic (to confirm or refute the disease) and surgical (therapeutic). Diagnostic hysteroscopy refers to office hysteroscopy, which does not require general anesthesia. It is carried out on an outpatient basis. The cost of an operation to remove a polyp and uterine fibroids depends on the chosen treatment method, the number and size of formations, their location, comorbidities, and many other factors.

Endometrial hyperplasia – what is it, causes, symptoms, signs, diagnosis, treatment

Causes

Symptoms

Classification

Complications

Diagnosis

Treatment 9000 3

Endometrial hyperplasia is a pathology characterized by the growth of the glands of the uterine mucosa. A healthy endometrium consists of glands and stroma, with the latter accounting for more than 50% of the area. With a disease, this ratio changes, and the glands begin to take a leading position in relation to the stroma.

Diagnosis of endometrial hyperplasia of the uterus is made only on the basis of histological examination. All other methods are auxiliary and help only to suspect the disease, but not to make an accurate diagnosis.

Without timely detection and proper treatment, the risk of cancer increases several times. The disease is quite common and is usually diagnosed around the age of 45.

Causes and triggers

Endometrial hyperplasia is a pathology that has many causes. Therefore, only a gynecologist can say exactly why the disease appeared.

The main triggers for the beginning of the restructuring of the uterine mucosa can be called the following factors:

obesity, when there is an increased release of estrogens in the adipose tissue;
age over 40 years;
genetic predisposition;
age-related changes in the body;
smoking and alcoholism;
the onset of menstruation at the age of less than 12 years;
late menopause after age 55;
too long menopause;
lack of ovulation for six months before menopause;
type 2 diabetes mellitus;
polycystic ovary syndrome;
infertility;
ovarian tumors against the background of hormonal diseases;
thyroid disease;
autoimmune conditions;
hormone treatment;
use of tamoxifen in the treatment of cancer.

Usually the disease is diagnosed against the background of high levels of estrogen with insufficient amounts of progesterone.

Symptoms

Symptoms of endometrial hyperplasia are not as pronounced as, for example, in inflammatory diseases. However, when questioned by a doctor, a woman may notice some unusual symptoms associated with menstruation. Particular attention is required when more than 35 days or less than 21 days pass between two periods. Abundant discharge of blood is noted, menstruation is plentiful.

Also a striking symptom is the discharge of blood between menstruation. Bleeding can last only a couple of days, and sometimes stretch for up to a week. In some patients, there is a lack of menstruation for more than six months.

Another sign of endometrial hyperplasia is the absence of pregnancy even during sexual activity without any protection. At the beginning of the menopause, small spotting is possible, which may appear from time to time or be long and appear regularly. And only in some cases there are complaints of headache, overweight, poor sleep, increased fatigue, irritability and decreased performance.

Classification

Glandular hyperplasia of the endometrium is an overgrowth of the glandular tissue of the endometrium, causing it to thicken and increase in size. The main manifestations are heavy periods, bleeding between periods, anemia and infertility. It can occur at almost any age, but is most often diagnosed against the background of the fading of hormonal function.

Focal endometrial hyperplasia is a pathology that manifests itself only in a certain area of the uterine mucosa. A distinctive feature is spotting spotting in the intermenstrual period, which is periodic. This leads to anemia of a chronic course, which occurs rather quickly against the background of the lack of treatment.

Simple endometrial hyperplasia is a condition in which no atypia cells are detected during histological examination. The main causes of this disease are abortions, curettage, hormonal disorders. Such a process never degenerates into malignant, but requires mandatory treatment.

Atypical endometrial hyperplasia is considered one of the most dangerous. It is divided into complex, simple and neoplasia. According to the results of the analysis, many genetic changes are noted here, and the risk of developing cancer exceeds 60%.

The main purpose of this classification is to separate benign and malignant hyperplasia, since further treatment tactics for such patients are very different.

Complications

The most common complication that is characteristic of this pathology is anemia. Anemia is due to the fact that a woman, in addition to normal menstrual bleeding, often has intermenstrual bleeding, and this significantly reduces the level of hemoglobin and iron in the blood.

The second most common complication is infertility. Moreover, a woman not only cannot conceive on her own, but even artificial insemination with the help of IVF does not bring results, since the quality of the endometrium suffers greatly, and attachment of the embryo is impossible.

But the most dangerous complication is degeneration into adenocarcinoma, that is, cancer.

Diagnostics

Endometrial hyperplasia, and what kind of disease it was described above, requires a thorough diagnosis, which will allow you to make an accurate diagnosis and begin adequate treatment. The diagnosis is based on the history, symptoms and complaints of the patient.

Transvaginal ultrasound is the main diagnostic test. However, the results obtained cannot be considered too reliable. In any case, a woman undergoes diagnostic hysteroscopy, which helps to examine the uterus from the inside and take the necessary tissues for histological analysis.

Endometrial hyperplasia in menopause is diagnosed on the basis of the thickness of the epidermis layer: normally it does not exceed 5 mm. Anything more than this requires a more thorough further diagnosis.

Curettage with endometrial hyperplasia is possible for diagnostic or therapeutic purposes, especially with severe and prolonged uterine bleeding, which has nothing to do with discharge during menstruation.

When diagnosing, the disease should be differentiated from a polyp, myoma, endometritis, endometrial cancer.

Treatment

The treatment of endometrial hyperplasia has 3 goals – to prevent the development of cancer, to exclude other concomitant oncological processes in the tissues of the uterus and to choose the right plan for further therapy after diagnosis. Therapy is chosen depending on the presence of atypia, based on the histological result.

If there is no atypia, endometrial hyperplasia is treated with drugs. The menstrual cycle is normalized with special preparations, if necessary, obesity is combated, oral contraceptives, cyclic gestagens are prescribed, and the Mirena intrauterine device is installed. Surgery for this type of endometrial hyperplasia is used very rarely.

After the course of treatment, two diagnostic hysteroscopies should be performed, and if both are negative, then the patient is considered healthy. Dufaston with endometrial hyperplasia should be prescribed only by a doctor, its independent and uncontrolled use can cause serious side effects.

Treatment of an atypical form is prescribed very rarely and only if the patient strongly desires to preserve the uterus. The main therapy is the surgical removal of the uterus, its cervix, and ovaries.

Surgical removal of endometrial hyperplasia is used for the following indications:

atypical form and age over 50 years;
the appearance of an atypical process during treatment, although initially during the examination the patient had a non-atypical form;
recurrent form, combined with uterine fibroids, adenomyosis or endometriosis.

After endometrial hyperplasia without atypia, the prognosis is usually good. In almost 96% of all cases, the pathology actively regresses, recurring in no more than 4% of all cases.

When diagnosing an atypical form, the effectiveness of treatment will be no more than 50% of all cases. In 25% of all cases, a relapse occurs, and in another quarter of cases, the disease turns into endometrial cancer.

The author of the article:

Shklyar Aleksey Alekseevich

obstetrician-gynecologist, surgeon, KMN, head of the direction “Obstetrics and Gynecology”

work experience 11 years

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I turned to Shklyar Aleksey Alekseevich I want to express my deepest gratitude to the whole team of the operating unit Aleksey Alekseevich Shklyar. You are all doctors with a capital letter. I never tire of thanking God for bringing me to you. I came to you on the recommendation of Sorvacheva M.V. We got in touch with the doctor by phone and appointed the day of the operation. For the first time, I was pleasantly surprised how Alexey Alekseevich told me everything in detail and reassured me. A couple of weeks later, I arrived at the clinic at 10.00 with a complete list of tests, and already at 11 I was lying on the operating table, to be honest, I didn’t even have time to get scared) Then the anesthetist magician came and I fell asleep sweetly. I woke up already in bed, nothing hurt, there were no side effects, just a normal morning awakening. I would never have believed that this was even possible, I am very grateful for a wonderful dream. Before that, I had more than one general anesthesia in state hospitals, and now I understand for sure that they apparently wanted to kill me there, but it didn’t work out. For the next two hours, until it was impossible to get up, wonderful nurses came to me asking how I felt and if I needed something, they put droppers, and I lay and did not believe that everything terrible was over)) 2 hours after the operation, I was already getting up and drank delicious broth and tea. The rest of the time before sleep, I walked around the ward, I didn’t feel any pain at all, a little weakness and nothing more. The next morning I was fed deliciously and discharged home. After being discharged, Aleksey Alekseevich is constantly in touch, he worries about my well-being more than even my relatives. I needed further treatment, he even helps me with this by calling the best doctors and clinics, supporting me. And now I know for sure that I am in the most reliable hands. Thank you very much again. Prosperity to your clinic and low bow to all your doctors. You are the best!!!

Lilia

15.05.2021 15:21:57

Clinic

m. On May 7, 2021, I did a minor gynecological operation in SOD, and I would like to express my gratitude to the attending physician, to the head of the gynecological department Shklyar Aleksey Alekseevich, – for high professionalism, and exceptionally friendly attitude, understandable recommendations. The doctor communicates very correctly, clearly and with explanations.
Special thanks to the anesthetist Alexey Valeryevich Fomin for the quality anesthesia (I was more afraid of anesthesia than the operation itself), but everything went well, I was “not present” at the operation, and the condition after anesthesia was normal, as after waking up in the morning, no “side effects” ‘ did not feel.
After the operation, nothing hurt after half an hour, and after an hour and a half, I went home.
The attitude in the hospital was the most friendly, including from the nurses and the administrator at the reception (unfortunately, I did not ask for names).
It’s been a week since the operation, and only the discharge summary # 140035314 reminds me of it.
I’m very glad that I trusted the experience of the Polyclinic.

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Initial appointment, consultation with an obstetrician-gynecologist3950

Specialization of the doctorAllergistAndrologistAnesthetistPediatrician house callPaediatrician house callGastroenterologistHematologistGynecologistBreastfeedingDermatologistPediatric allergologistPediatric gastroenterologistPediatric gynecologistPediatric dermatologistPediatric infectious disease specialistPediatric cardiologistPediatric ENT specialistPediatric chiropractorPediatric massagePediatric neurologistPediatric neurologist phrologistPediatric oncologistPediatric osteopathPediatric ophthalmologistPediatric psychiatristPediatric traumatologistPediatric urologistPediatric surgeonPediatric endocrinologistPediatric departmentDietologistImmunologistInfectionistHeadache roomCardiologistCosmetologistENT doctor (otolaryngologist)MammologistManual therapistMassageNarcologistNeurologistNeurologistNephrologistOncologistOperational unitOsteopathOt department of pediatrics m. TherapistTraumatologist-orthopedistTrichologistUltrasound (ultrasound examination)UrologistPhysiotherapistPhlebologistSurgeonSurgical operations under the compulsory medical insurance policy of the Moscow RegionEndocrinologistAesthetic gynecologyClinics. Smolensk. Taganskaya. Street 1905 years. Red Gates. AvtozavodskayaPharmacy. Glades. Sukharevskaya. st. Academician Yangelam. Frunzenskaya Zelenograd

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